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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600490

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Neil DuncanPeck Sex Male

Date of Birth March 8, 1921 Place of Birth River HebertCounty of Cumberland

Name of Father Percy Peck MAIDEN NAME of Mother Lovia May Negus

Residence of Father when child was born River Hebert, Cumberland Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father River Hebert, Cumberland Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Percy Peck Address of Applicant River Hebert, Cumberland Co., NS Date 13 May 1941

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Neil DuncanPeck

Born at River Hebert in the County of Cumberland

That Neil DuncanPeck Whose Birth is sought to be registered was

born at River Hebert Cumberland County on March 8, 1921

My knowledge of the fact and date of such Birth is based on the following Circumstances:

I am the mother of the above named Neil Duncan Peck and as such have personal knowledge of the above stated facts and declare that are all true.

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